The H1N1 pandemic virus is subsiding as children enjoy their summer vacation but public health officials warn that the disease could gain new momentum when schools reopen in September.
Experts simply don't know if and when the virus will regroup and in what form, David Butler-Jones, Canada's chief medical officer of health, told a news conference Wednesday afternoon.
"It's anybody's guess," he said. "Influenza is always inventive."
It could wait until normal flu season, which begins in December. Or, with the aid of classrooms serving as incubators, it could gain strength when summer comes to an end - well before a vaccine is expected to be ready for distribution in mid-November.
The Public Health Agency of Canada issued guidelines for schools yesterday to help manage what could potentially be widespread and severe illness.
In fact, the advice offered in the documents amounts to little more than common sense. Hands should be washed, parents and teachers should monitor for symptoms, health officials should be informed of major outbreaks, sick children should be kept home or isolated if they fall ill at school and surfaces that are frequently touched should be frequently cleaned.
Secondary and postsecondary schools that have more extracurricular activities and accept students from other jurisdictions may have to curtail travel. And those with dormitories will have to consider isolation if students get sick.
Most school boards and universities already have plans in place. Some are considering restricting or cancelling public gatherings if the flu spreads. And there were reports last week that two Quebec City school boards planned to keep pregnant teachers at home this fall because of the swine flu threat. Pregnant women are among the hardest hit by the H1N1 virus.
Federal health officials do not recommend closing a school unless there are so many teachers or students absent that it makes no sense to stay open.
If a school is closed, "you take that controlled situation and create an uncontrolled situation," Dr. Butler-Jones said. Parents may be forced to stay home, disrupting their workplace. Or they may have to go to their job. "Then you have kids relatively unsupervised and young teens and others in the mall potentially spreading it to seniors in the malls."
If the flu returns in September, inoculation won't be an option until two months into the outbreak.
"If it reappears earlier than we expect, then the social distancing ... staying home if you're ill, will slow it down," Dr. Butler-Jones said. And antiviral drugs such as Tamiflu "will slow it down and buy us time until we get the vaccine."
The safety and effectiveness of the vaccine is still unknown, he said. But he thinks vaccination is the obvious choice.
"Certainly, the experience would suggest that the side effects are what you would expect, not extraordinary. And, as we know, the side effects from the flu can be pretty dramatic and terrible."
At least one study, however, has recommended that children under 12 not be mass immunized.
Alberta, meanwhile, has announced that it is considering paying some doctors up to $518 an hour to treat swine-flu patients during a serious outbreak.
And the federal government dismissed a recommendation by the Canadian Medical Association Journal to name an independent "health czar" who could compel provinces to follow orders in fighting the H1N1 pandemic this fall.
"I don't think that's the direction we want to go," Health Minister Leona Aglukkaq told reporters Wednesday. "The success of ... managing the pandemic requires the provinces to be key partners in the delivery, and the co-operation has been outstanding from provinces and territories as we deal with the situation."
With a report from The Canadian Press
Caroline Alphonso